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Emerging Indications for Hyperbaric Oxygen Therapy

Table of Contents: Emerging Indications for Hyperbaric Oxygen TherapyBy Prof. Enrico Camporesi, MD, FASA, FUHM; Gerardo Bosco, MD, PhD; Prof. Shai Efrati, MD Brief Description of Lectures: Aseptic bone necrosis and hyperbaric oxygen therapy - Enrico Camporesi, MDMultiple sites of the skeleton sho ...Read more

  • Course Description
  • Course Credits

Table of Contents:

Emerging Indications for Hyperbaric Oxygen Therapy
By Prof. Enrico Camporesi, MD, FASA, FUHM; Gerardo Bosco, MD, PhD; Prof. Shai Efrati, MD

Brief Description of Lectures:

Aseptic bone necrosis and hyperbaric oxygen therapy - Enrico Camporesi, MD
Multiple sites of the skeleton show aseptic necrosis, which is amenable to improvement with HBO2.

Hyperbaric preconditioning - Gerardo Bosco, MD, PhD
Preconditioning (PC) has been described as the hyperbaric oxygen (HBO2) experience before a critical event. Its aim is to prevent a specific clinical condition, and it is developing as a valuable complement both in diving medicine (Bosco, 2010) as well as prior to ischemic or inflammatory situations. PC is a preventive treatment that triggers endogenous cascades, which can protect from stress-activated and stress-reactive responses. A possible mechanism of HBO2-PC mediating beneficial effects has been described as attenuation of the production of proinflammatory cytokines in response to an inflammatory stimulus such as surgery and modulation of the immune response. HBO2-PC protocols are performed at 2.0–2.5 atmosphere absolute (ATA), and usually only applied for one or a few days. The physical adaptations in response to alterations in atmospheric oxygen appear to extend not only to survival, but also a preconditioned state. Similar to ischemic and stress preconditioning, many different paradigms have been used to demonstrate that either rapid or delayed tolerance is affected by HBO2. Irrespective of the cause of injury, inflammatory cytokines released after the primary event trigger leukocyte activation and free radical release, causing secondary damage and extension of injury.

Brain injury - Shai Efrati, MD
Clinical studies published in recent years present convincing evidences that hyperbaric oxygen (HBO2) therapy can be the coveted neurotherapeutic method for brain repair of neurological incidents like traumatic brain injury and stroke. This new understanding leads to a paradigm change in the way that we refer to chronic brain injuries; from now on these should be thought of like other non-healing wounds in other parts of the body. The classical candidate for HBO2 is a patient with unrecovered brain injury where tissue hypoxia is the limiting factor for the regeneration process. In this patient, HBO2 may induce neuroplasticity in the stunned regions where there is a brain anatomy/physiology mismatch (as for example PET/MRI). In this lecture we will discuss the multifaceted role HBO2 can play in neurotherapeutics based on recent persuasive evidence demonstrating HBO2 efficacy in brain repair as well as a new understanding of brain energy management and response to brain damage. We will also discuss how to select suitable candidates and how to choose the optimal HBO2 protocol for the selected candidate.


  1. Recognize and score the presentations of aseptic osteonecrosis.
  2. Evaluate the human burden of the disease.
  3. Suggest an appropriate dosing of hyperbaric oxygen treatment.
  4. Preconditioning is a safe therapeutic approach to reduce inflammation and prepare patients for surgery or divers for immersion.
  5. Basics of pathophysiological cascade of non-recoverable brain injuries.
  6. The neuroplasticity effect of hyperbaric oxygen therapy.
  7. Selecting the optimal candidate for HBO2 treatment.


  • Non-Member: $45
  • Regular UHMS Member: $35
  • Associate UHMS Member: $25

Estimated time to complete this activity: 2 hours

Accreditation Statement: The Undersea and Hyperbaric Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Disclosure: All faculty members and planners participating in continuing medical education activities sponsored by UHMS are expected to disclose to the participants any relevant financial relationships with commercial interests. Full disclosure of faculty and planner relevant financial relationships will be made at the activity.

Designation Statements (CME/CEU Approvals):

Physician CME: The Undersea and Hyperbaric Medical Society designates this enduring material for a maximum of 2 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

MOC ABPM: The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 2 LLSA credits towards ABPM MOC Part II requirements.

Nursing/RRT: This enduring material is approved for 2 contact hours provided by Florida Board of Registered Nursing/RRT Provider #50-10881.

For NBDHMT: This enduring material is approved for 2 Category A credit hours by National Board of Diving and Hyperbaric Medical Technology, 9 Medical Park, Suite 330, Columbia, South Carolina 29203

Termination Date: June 4, 2022

Disclaimer: The information provided by this CME material is for Continuing Medical Education purposes only. The lecture content, statements or opinions expressed however, do not necessarily represent those of the Undersea and Hyperbaric Medical Society (UHMS), its affiliates or its employees.

Goal: For over 40 years the UHMS has been the primary source of information for hyperbaric medicine and physiology worldwide. This enduring material has as its goal to address identified professional practice gaps and provide a quality CME opportunity which will improve scientific knowledge and skills for hyperbaric and wound care: physicians, nurses and technicians, and other clinicians and personnel whose practice includes hyperbaric medicine and wound care.

Target Audience – physicians, nurses, CHT’s or anyone with an interest in diving and hyperbaric oxygen therapy.

All individuals in control of content for this educational activity with their relevant financial relationship disclosed are listed below. ACCME defines a relevant financial relationship “as financial relationships in any amount occurring within the past 12 months that create a conflict of interest.” An individual who refuses to disclose relevant financial relationships will be disqualified from being a planning committee member, a teacher, or an author of CME, and cannot have control of, or responsibility for, the development, management, presentation or evaluation of the CME activity.


Name of IndividualIndividuals Role in ActivityName of Commercial Interest (If Applicable)Nature of Relationship
Prof Enrico Camporesi, MD, FASA, FUHM Faculty None None
Gerardo Bosco, MD, PhD Faculty None None
Prof. Shai Efrati, MD Faculty None None
Stacy Harmon, BS Planner/Reviewer None None
Tom Bozzuto, DO UHMS Reviewer None None
Owen J. O’Neill, MD UHMS Reviewer None None
Ben Slade, MD UHMS Reviewer None None
Helen Gelly, MD UHMS Reviewer None None
Robert Sanders, MD UHMS Reviewer None None


About the presenters:

Dr. Enrico Camporesi is Emeritus Professor and Past Chair, Department of Anesthesiology & Critical Care, University of South Florida College of Medicine. He currently serves as Editor-in-Chief, Undersea and Hyperbaric Medicine Journal.

Dr. Gerardo Bosco is associate Professor in Sport physiology, Director of Master II level in Diving and Hyperbaric Medicine Course in technical and health management in the hyperbaric chamber Department of Biomedical Sciences, University of Padova.

Dr. Shai Efrati is a professor at Sackler School of Medicine and the Sagol School of Neuroscience of Tel Aviv University and the director of the Sagol center for hyperbaric medicine and research at Assaf-Harofeh Medical Center in Israel. The center, under Prof. Efrati management, has become one of the largest hyperbaric center worldwide, currently treating more than 200 patients per day. Prof. Efrati is also the director of Research & Development of Assaf-Harofeh Medical center, affiliated to Tel-Aviv University. Taking the two passions/positions together Dr. Efrati has initiated a research program focusing on the neuroplasticity (regeneration of damage brain tissue) of Hyperbaric Oxygen Therapy (HBO2). In the first clinical studies it was proved that HBO2 can induce neuroplasticity in post stroke and Traumatic Brain Injury even years after the acute Insult. The important clinical results gained from the research program have led to fruitful ongoing cooperation including multidiscipline team focusing on the regenerative effects of hyperbaric oxygen in various types of injuries.

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Continuing Education Credits are provided when a participant passes the course with 60% or higher on their overall grade of the course quizzes. Each quiz also will allow two attempts. If a participant fails the course, the UHMS will allow a re-take of the course at a 50% discount to their designated full price rate.

The information provided at this CME activity is for Continuing Medical Education purposes only. The lecture content, statements or opinions expressed, however, do not necessarily represent those of the Undersea and Hyperbaric Medical Society (UHMS), its affiliates or its employees.
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